Epilepticus sic curabitur

The business of "curing epilepsy" by brain surgery is booming.

Owing to this very sexy, surgical practice, government and private donations have risen to unprecedented levels; a new sub-specialty of neurology has been created; pharmaceutical companies have worked overtime to deliver new drug therapies, and epilepsy research thrives.

But one must query whether a heightened technological approach to brain surgery really represents progress against epilepsy. If we look backwards a little, we may gain some unexpected perspective.

This image is titled Epilepticus sic curabitur ('The way to cure an epileptic'), from the Sloane Manuscript collection of medical manuscripts, 12th century, British Museum, London.

It represents what you think it represents: brain surgery. In this case, trepanation (opening the skull) and cauterization. Seems as if brain surgery to cure epilepsy is nothing new.

There were mystical, superstitious reasons for trepanation operations to be performed: it was thought that opening the skull cap would cause the demons of the sickness, poisonous gases or disease-causing juices to escape.

Dr. John R. Mangiardi and William Howard Kane,"Pre-Columbian Brain Surgery", say successful trepanation has taken place as far back in human time as 7,000 B.C. .

Ancient Greeks, Romans, Egyptians, British bog men, neolithic Frenchmen, and hosts of others around the globe, would trephine the skull of their patients to cure a head wound, or as a way to cure epilepsy. The urbanites of the New World carried it out with stunning success rates. We know all of this because we have archaeological evidence from human groups showing that patients received this kind of care and then lived out their lives, instead of dying from the practice.

Trepanation gained cult status in the late 20th century when it became touted as a kind of do-it-yourself cure for social angst of all kinds. Contemporary trepanists believe that boring a hole into one's skull makes them happier, more enlightened beings. Male trepanists frequently believe that a hole in the head will keep them young and vital.

Sounds like 12th century thinking to me.

Before I conclude, let me tell you a story...One of my very favorites, whether urban myth or true, is the tale of a man, newly diagnosed with epilepsy. He acquired a head injury from an ordinary car accident and the consequence was E. Frustrated by the cruel impact his new condition has made on his life, the man determines to see if he is a surgical candidate. Sure enough, he is!

He remains steadfast in his resolve, even when told half of his brain will need to be removed. "Whatever it takes to rid me of my seizures!" the man says.

So, the man has surgery to remove the section of his brain causing his epilepsy. His surgery is a complete success, he is rehabilitated, and his seizures vanish. He is a new man. But, five years later, the man is a passenger in another car and suffers a second head injury from an accident. Again, the consequence of his injury results in epilepsy...and this time the man is informed he hasn't enough of a brain left to make him a surgical candidate...

For those who have made the decision in favor of a surgical remedy to their epilepsy, my admiration is sincere. Unlike you, this is not a decision I will ever make: I like my skull intact, my brain sealed off from the air. I neither seek this kind of "cure" at the hands of contemporary surgeons, nor am I convinced of any variation of trepannist philosophy.

But, in its social and cultural contexts, I find an examination of brain surgery offers an interesting view of human endeavor.